中国修复重建外科杂志最新文献

Reconstruction of missing thumbs or fingers remains one of the most demanding challenges in hand surgery. Over the past century, toe-to-hand transplantation has evolved from early experimental pedicled transfers into a highly refined microsurgical procedure, now widely regarded as the "gold standard" for restoring hand function. This article reviews the historical and technical development of toe transplantation-from Nicoladoni's pioneering concepts in the late 19th century, through Dr. YANG Dongyue's landmark second-toe transfer performed in 1966, to contemporary Chinese contributions such as the "total-shape reconstruction" paradigm. Modern surgical practice incorporates individualized strategies and advanced techniques, including Dr. GU Yudong's supplemental vascular-supply design and Dr. CHENG Guoliang's dual-pedicle bridging method, which collectively enhance functional recovery, aesthetic outcomes, and reliability. Emerging innovations such as three-dimensional-printed osseous scaffolds, artificial intelligence-assisted surgical planning, and tolerance-oriented transplant engineering are further driving the field toward greater precision, reduced morbidity, and improved long-term results.

Bone infection as one of the most challenging diseases in orthopedics, is characterized by a prolonged treatment and a high recurrence rate, imposing a significant disease burden on both patients and society. With the continuous emergence of drug-resistant bacteria and a deepening understanding of biofilm theory, traditional single-modality treatment have become inadequate in addressing these complex clinical challenges. This paper provides an in-depth analysis of the century-long dilemma in the treatment of bone infections. Through systematic theory, it shares the author's "Chongqing experiences" in bone infection management-a systematic strategy proposed based on extensive clinical practice and theoretical summarization. This approach emphasizes the importance of multi-disciplinary treatment, staged treatment, precise debridement, and a comprehensive grasp of the principles underlying bone infection therapy. The article also discusses humanistic considerations and future prospects in the treatment of bone infections, aiming to offer practical and valuable basis for clinical management.

Against the backdrop of increasing subspecialization in medicine, the Chinese Journal of Reparative and Reconstructive Surgery has established itself as a crucial academic platform for clinical and basic research involving multidisciplinary integration, focusing on the interdisciplinary field of reparative and reconstructive surgery. The year 2026 will mark the 40th anniversary of the journal's founding. This article reviews its developmental trajectory and discusses the definition of limb reconstruction, the evolution of relevant academic societies, advancements in prosthetic technology, and the concept of extreme reconstruction. In its narrow sense, limb reconstruction addresses defects, infections, and deformities, while broadly, it encompasses comprehensive treatment requiring multidisciplinary collaboration. The evolution of international academic societies from the Association for the Study and Application of Methods of Ilizarov (ASAMI) to International Limb Lengthening and Reconstruction Society (ILLRS) reflects both divergence and convergence in technical philosophies, with Chinese scholars playing a proactive role in this process. Advances in prosthetic technology, particularly in intelligent bionic prostheses and osseointegrated mechanoneural prostheses, have raised the standards for the precision of amputation surgeries and stump reconstruction, thereby fostering the development of the "maximum limb reconstruction" philosophy. This philosophy emphasizes a coherent three-stage approach (early, intermediate, and late) that integrates microsurgery, Ilizarov techniques, infection control, and soft tissue repair to achieve optimal restoration of structure, function, and morphology. By concentrating on multidisciplinary integration, the Chinese Journal of Reparative and Reconstructive Surgery has contributed significantly to the development of a limb reconstruction system with Chinese characteristics and is poised to continue leading progress in technological integration and academic innovation within this field.

The successful replantation of a severed limb by CHEN Zhongwei in 1963 marked the beginning of microsurgery in China. The complete survival of a completely severed finger replantation and the successful free transplantation of the second toe to reconstruct the thumb in 1966, as well as the successful transplantation of a free inguinal skin flap in 1973, were all landmark achievements. The Guangzhou Experience Exchange Conference on Limb Replantation in 1972 and the American Replantation Mission to China in 1973 promoted academic exchanges and technology dissemination both domestically and internationally in China's microsurgery field. China's limb (finger) replantation techniques and principles were recognized and promoted worldwide, and Chinese microsurgery developed in step with the world and created many world firsts. Since then, Chinese microsurgery has long been among the advanced academic ranks internationally.

The undulating characteristics of nerve fibers and the endoneurium are important factors in resisting traction force. The diagnostic accuracies of magnetic resonance neurography and ultrasonography for nerve injuries are 85.4% and 70.6%, respectively. Epineurial repair is the most commonly used nerve repair technique. Nerve grafts are generally required when the defect exceeds 2 cm. Nerve transfers are primarily indicated for brachial plexus root avulsions or intraforaminal lesions. Painful neuromas can be treated with target muscle reinnervation. Surgery yields reliable results for carpal-tunnel syndrome, cubital-tunnel syndrome, the common peroneal nerve entrapment, and the lateral femoral cutaneous nerve entrapment syndrome. Effective rehabilitation interventions related to the central nervous system include sensory reeducation, cross-modal sensory substitution, motor imagery, and action observation with simultaneous peripheral nerve stimulation.

Reduction is the first step in fracture treatment, and is the predominant factor for treatment outcomes. The positive anteromedial cortical support reduction theory was established by Professor Shi-Min Chang in 2014 for the fixation treatment of trochanteric femur fractures. It was referenced to the nonanatomic reduction theory proposed by Gotfried in 2013 for subcapital femoral neck fractures. Both are nonanatomic cortical support reductions to share medial compressive load, but were just the opposite with each other in the bearing and direction of the proximal head-neck fragment. For femoral neck fractures, positive cortical support means the proximal femoral head-neck fragment is intentionally positioned slightly lateral-superior to the distal neck (less than 1 cortical thickness) and is intramedullarily buttressed by the distal inferior cortex. For trochanteric femur fractures, positive cortical support means the proximal head-neck fragment is deliberately positioned slightly medial-superior to the distal shaft (less than 1 cortical thickness) and is extramedullarily buttressed by the anteromedial cortex of the femoral shaft. Currently positive reduction theory and its derivative Chang reduction quality criterion (CRQC) is widely accepted and practiced worldwide, and are appraised as one of the three keystone theories in the treatment of trochanteric femur fracture, which are tip-apex distance, lateral wall, and cortical support reduction. From the point of scientific methodology, this new theory establishment is related to several important factors, such as identify unusual events in clinical practice, seize the opportunity, abundant knowledge reserves, keep up with the latest progress, conduct analogical reasoning, and promptly summarize the results and publish academic papers.

Objective: To explore the effectiveness of the flexor digitorum longus (FDL) transfer combined with single-bundle spring ligament reconstruction and medial displacement calcaneal osteotomy in the treatment of stage ⅠAB progressive collapsing foot deformity (PCFD).

Methods: Between January 2019 and September 2023, 19 patients (19 feet) with stage ⅠAB PCFD were treated with FDL transfer combined with single-bundle spring ligament reconstruction and medial displacement calcaneal osteotomy. There were 11 males and 8 females, aged 18 to 60 years, with an average age of 45.5 years. Nine cases were on the left foot and 10 cases on the right foot. The disease duration was 9-21 months, with an average of 12.3 months. Postoperatively, the effectiveness was evaluated by visual analogue scale (VAS) for pain, American Orthopaedic Foot and Ankle Society (AOFAS) score, and Tegner score. Based on X-ray films, the talonavicular coverage angle (TNCA), talus-first metatarsal angle (T1MT), Meary angle, and pitch angle were measured. The plantar pressure parameters of the foot were measured by the Footscan plantar pressure measurement system, including peak pressure and load of the forefoot, midfoot, and hind foot. The patients' satisfaction with the surgical outcome was evaluated.

Results: All 19 surgeries were successfully completed. One patient had poor incision healing after operation, while the incisions of the remaining patients healed by first intention. All patients were followed up 12-28 months (mean, 16.8 months). At last follow-up, the VAS score significantly decreased compared with that before operation, and the AOFAS score and Tegner score significantly increased ( P<0.05). Radiological measurements showed that the TNCA, T1MT, Meary angle, and Pitch angle all significantly improved compared with those before operation ( P<0.05). Plantar pressure tests indicated that the peak pressures of the forefoot and midfoot significantly reduced compared with those before operation ( P<0.05), while the peak pressure of the hind foot showed no significant change ( P>0.05). The forefoot load significantly increased and the midfoot load decreased compared with those before operation ( P<0.05), while the hind foot load showed no significant change ( P>0.05). The total satisfaction rate of patients with the surgical outcome (very satisfied+satisfied) reached 84.2% (16/19).

Conclusion: The FDL transfer combined with single-bundle spring ligament reconstruction and medial displacement calcaneal osteotomy can effectively correct the stage ⅠAB PCFD, improve the abnormal distribution of plantar pressure and load, alleviate foot pain symptoms, and improve foot movement function. The patient's satisfaction is high. However, the long-term effectiveness still needs to be further observed and clarified.

Objective: To summarize the research progress on augmentation repair of anterior talofibular ligament (ATFL) under arthroscopy.

Methods: The domestic and international studies from the past decade on augmentation repair techniques for the ATFL. The advantages and limitations of each approach were summarized and the outcomes of these augmentation repair techniques when applied to ATFL repair were evaluated.

Results: Mechanical augmentation technique (suture tape or internal brace technique, double anchor enhancement technique) can increase the strength after ATFL repair, but it will increase the economic burden of the patients; bioenhanced repair technology (inferior extensor retinaculum enhancement, anterior tibiofibular ligament's distal fascicle transfer augmentation) can also increase the strength after ATFL repair, but it will damage the anatomical structure in the ankle cavity to a certain extent, and the surgery is difficult, and the operation time will prolong and also increase the incidence of perioperative complications. Regardless of the augmentation repair techniques used, the benefits are higher for patients with high exercise needs, and active postoperative rehabilitation is required to maximize the surgical effect.

Conclusion: Although augmentation repair of ATFL offers several advantages, its use-whether augmentation should be employed and, if so, which technique is preferable-requires further study across patient subgroups owing to increased costs, potential disruption of ankle anatomy, and longer operation time.

Objective: To summarize the biomechanical research progress of biomaterials in rotator cuff injury repair and to explore how biomaterials can restore the native histological and mechanical properties of the rotator cuff.

Methods: The relevant literature at home and abroad was widely reviewed to analyze the biomechanical properties of synthetic biomaterials, naturally derived biomaterials, and tissue grafts in the repair of rotator cuff injuries.

Results: Synthetic biomaterials [such as poly (lactic-co-glycolic acid) and polycaprolactone] can provide initial stable mechanical support due to their adjustable mechanical properties and degradation characteristics, while naturally derived biomaterials (such as collagen and hyaluronic acid) can promote cell adhesion and tissue integration due to their biocompatibility and bioactivity. Tissue grafts exhibit significant clinical utility by providing immediate mechanical stability and promoting tendon-to-bone healing. Three-dimensional bioprinting technology provides new possibilities for personalized repair of rotator cuff injuries by precisely controlling the spatial distribution and mechanical properties of biomaterials.

Conclusion: Future studies should further optimize the design of bioprinting materials, cell sources, and scaffolds to achieve better mechanical properties and clinical efficacy of biomaterials in the repair of rotator cuff injuries.